
	Required Fields The Tri an Mhi Quarryman Triathlon RegistrationRace Date: Saturday, September 12th 2009 Please have you Credit Card ready for secure payment with PayPal* note:You DO NOT need to have an account with PayPal to finalize payment Save my progress and resume later \| resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Please Choose: Individual(€40) or Team Relay Registration(€75) * Number Of Team Members * TwoThree Participant Information Note: If you are NOT a member of Triathlon Ireland then you are required to pay for a 1-Day licence fee. It will automatically be added on to Payment Total below. All TI member numbers must be shown and verified on race day. Are You A Member Of Triathlon Ireland * YesNo TI Number * Please enter the rest of your TI number First Name * Last Name * Address Example: Street, Road, Town, County. E-Mail * [email protected] Club Phone Mobile Phone Date of Birth(dd/mm/yyyy) * Gender * MaleFemale T-Shirt Size: Team Member 2 Are You A Member Of Triathlon Ireland * YesNo TI Number * First Name * Last Name * Address E-Mail * Club Phone Mobile Phone Date of Birth(dd/mm/yyyy) * Gender * MaleFemale T-Shirt Size: Team Member 3 Are You A Member Of Triathlon Ireland * YesNo TI Number * First Name * Last Name * Address E-Mail * Club Phone Mobile Phone Date of Birth(dd/mm/yyyy) * Gender * MaleFemale T-Shirt Size: Registration Fees Total€ Save my progress and resume later \| resume a previously saved form Need assistance with this form?